The reality is home health care is where the jobs are. - page 2

by paradiseboundRN

6,721 Views | 18 Comments

This is the new reality. Medicare wants patients out of the hospital as soon as possible and does not want them readmitted (at least within 30 days). So one of the specialties with the most jobs for the near future is home health... Read More


  1. 0
    I work in home health and I'm still relatively new to nursing (but not to the world of work or of self-starting work, either). I don't know if it helps that I'm an experienced health care worker first and a nurse second, or that I'm well into my third (or is it fourth?) career, but I LOVE the work & I am so grateful that I was given the opportunity to develop into a better nurse in this specialty. My agency has been very careful about helping me ramp up, moving out of orientation to patients who were less critical first, then slowly as I felt more comfortable, to patients requiring a bit more attention. My supervisor has also been invaluable and quickly available by phone. As MBrickle pointed out, this is going to be the place more and more of us are going to start, because honestly, especially in the over-populated nursing world of places like the Northeast, hospitals just aren't hiring us. The difficulty is that, as in most fields, no one wants to pay for mentoring to happen over a long period of time. The ideal would be if home health agencies sent nurses out in pairs, to give new RNs time to develop the sort of instinct that QueenNasus talks about. But is there any company out there doing that more than during a brief orientation period?
  2. 0
    Where I work the nurses get anywhere is from a 2 -3 months or longer orientation period. I do PICC line, wound vacs, multiple tasks, I have any where from 5 to 6 visit in the day I personally have 1 of the highest mileage is in the company but I do get reimbursement at 50 cents a mile. But my area is very rural area some girls work in the city and drive 10 20 miles a day. Yes talking on the phone is a great part of my work and because of my mileage I do work at home but when I get my charting done in the home it's a lot easier. we do oasis but it is the nursing admission, discharge and or change of condition. I get paid by the hour and if I go over my required visits I get extra pay or I can file for overtime which it time sometimes it's not granted my hours are fairly flexible there are times when people don't wake up till late after noon ok people that have to be seen in the morning or I be in a biotic say have to be administered at a certain time but I do make my doctor's appointment I do get to see my grandchildren things at school I just drop off my grandson to school every single day I have flexibility where if I need to do my visits in a hurry and chart later I can. I have a lot of autonomy. My caseload is anywheres from 15 to 25 patients they don't all need to be seen every day I work with an LPN and between them we get our visits done also I have to rely very heavily on the LPN who is a godsend I get called anytime this changes in the patient. Do I love my job yes what I change it No I've done Hospital nursing I've done nurse managing in a nursing home I love everything I've done but the rewards that I have of being able to spend 1 on 1 time with my patient is by far much more rewarding is this setting. Because my agency is affiliated with the hospital in a large city my Pay is comfortable with the hospital pay which puts me at a very nice pay scale. I know for a fact my pay is just a few dollars less an hour than the DON at the nursing home i used to work with. A few years back she tried to hire me back and the pay offered was over 6$ less an hour than i was making then. On the down side yes I work on call yes I work holidays because being sick is a 24 hour 7 day a week issue. Yes I come across the cranky people but being nice and helping them usually wins them over although sometimes it doesn't work yes I do get my heart broken a lot especially when I have to discharge people that I know need help but I do need to follow the Medicare rules. I do a lot of teaching which is where my flexibility of time is really helpful if I need to spend half an hour or an hour teaching somebody about the disease process I can do it I don't have to rush them but 1 of my biggest issues is I'm out there alone it is my assessment skills that is being tested every day my creativity with dressings to get them to stay on because if not somebody to be called out there later that day. And like I said before there are sometimes days between visits where my call will make a difference between whether they do better or not. It is definitely not an easy job it is not no brainer type of job you have to know what you're doing if your new coming into this as a nurse you really need to be able to think on your feet.
  3. 0
    I agree, but the question is...How do new grads get experience if there are no hospital jobs??
  4. 3
    I started out as a new grad in HH. It allowed me to learn to advocate, hone my assessment skills, make decisions that will benefit a pt, be comfortable in interventions regarding sending pt's out, HCP collaboration, educate and. collaborate with families, and acquire a multitude of skills; ie trach vent certification. The current agency i worked with was very supportive, you shadowed with a HC nurse, even if you have experience. It really depends on the agency, as well as the person. A lot of HH position gives you opportunities to do complex wound care, and infusion therapy. If anything the more complex the pt , the opportunities to move into acute care can happen. My HH experience allowed me to be hired in CC, as a new RN...so there is a plus in being in HH, you have to be receptive of it. And most facilities are aware if how many complex pts are going home and receive HH services...HH can be as highly skilled as acute care, just with one pt. With the RIGHT type of agency, you are never alone.
    gemberly, njgrl622, and paradiseboundRN like this.
  5. 0
    I agree wholeheartedly with QueenNasus! There are some things that you can only learn from experience and I don't feel home care is the place to learn. You need to be able to walk in, look at that pt and know if something isn't right! There is no back up in the home, you're it and one bad move could cost a pt their life!
    Last edit by grneyes8 on Jan 6, '13 : Reason: missed a word
  6. 0
    Quote from grneyes8
    I agree wholeheartedly with QueenNasus! There are some things that you can only learn from experience and I don't feel home care is the place to learn. You need to be able to walk in, look at that pt and know if something isn't right! There is no back up in the home, you're it and one bad move could cost a pt their life!
    I agree. But how are new grads going to get their experience if the hospitals are not hiring? We all agree what's best. But what about reality?
  7. 2
    I know that the hospitals aren't hiring new grads but a new nurse in home care could lose her license pretty quickly if she doesn't know what she's doing. Ideally they would offer extra training to new nurses but we know that probably isn't going to happen in most cases. They're going to want them out there making money. Not sure what the answer is.
    tewdles and Not_A_Hat_Person like this.
  8. 1
    I started out as a new grad LPN in HH. The companies I have worked for in the Northeast have at least 20 hours of preceptorship for a new grad, as well as the Clinical managers who make weekly visits, as well as classroom time before you are out on the field-experienced nurse get 8hrs class room and 12-16hrs preceptorship ...these are the requirements set by Medicare and insurance companies to make sure they are compliant-as well as Joint Commission standards. It does depend on the company you work for, if its Joint-Commission based, expect that process. You also don't get a complex case in the beginning, regardless of your experience. The purpose is to make sure you are comfortable in handling basic nursing care..give you opportunities to build on complex skills by going through educational courses, making sure you can handle a complex case, i.e. TPN/infusion, trach/vent cases, wound care visits, etc. The educational/competency evaluation is more if a liability issue, so if you don't think you are getting enough education and support, you can always report them...they want to be accountable to provide safe care so they won't be dinged by the government, as well as lose a case-they will be hit double time if they did not have education on risk management, ethics, documentation, safety, all the things that are required to be aware of as a nurse.

    I found that most of my co-workers were able to get hospital jobs, especially in critical care, because they were trach-vent nurses...there are ALWAYS a shortage of trach/vent nurses in home care, especially in pediatric HH. I am grateful of the support that they were willing to be always available to support me, as well as the critical thinking, and advocacy skills I was able to develop in HH. I am a better teacher to pts and families because of HH...I think there is a MYTH that HH nurses can't cut it the hospital, but that's the opposite...it seems like hospitals are taking in HH nurses (like myself) and HH is welcoming hospital nurses with open arms, for the invaluable skills that both arenas possess.
    paradiseboundRN likes this.
  9. 0
    Certain home health jobs are ridiculously easy to get into in my city. Within 1 week of taking the nclex, I walked into two pediatric HH agencies and was immediately offered employment. One wants to start me on patients with g-tubes only, the other wants me to start trach care right away. I was blown away by how one can get a job by simply showing up. The pay is comparable to LTC's in my area, and it's an easy way to get your year of experience. In fact, the recruiters use that as a way to get LPN's to sign up, advertising that you can work for them and receive no benefits/per diem work, but they will grant you what is so difficult to get: new grad training.

    It's a scary world out there sometimes.


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